August 20, 2010
CHIEF FINANCIAL OFFICER MEMORANDUM NO. 02 (2010-2011)
SUBJECT: CONTRACT SUMMARY FORM
Chief Financial Officer Memorandum No. 1 (10-11) issued a revised Contract Summary Form
that must be properly completed and submitted with all contractual services and grant payment
requests. The purpose of this memorandum is to disseminate an updated Contract Summary
Form and to clarify when it is to be used.
Except for contracts and grants which have no total amount or the total amount is $1 million or
more, the Bureau of Auditing does not require the agreement (including direct orders/purchase
orders) to be submitted to the Bureau. The Contract Summary Form is submitted in lieu of the
actual agreement when the agreement does not meet the established threshold.
For payments processed through MyFloridaMarketPlace, agencies must provide only the amount
paid to date and the contract manager’s written certification as shown on the Contract Summary
Form. The Contract Summary Form may be attached to the Invoice Reconciliation to provide
this information or the contract manager’s certification statement (contained on the Contract
Summary Form) and the paid to date information may be entered in the MyFloridaMarketPlace
comment field by the contract manager along with his/her name. Alternately, this information
may be provided on the invoice itself.
Payments processed directly in FLAIR must be supported by a properly completed Contract
Summary Form unless the agreement is either on file with the Bureau or is attached to the
payment request. If the agreement is on file or is attached to the payment request, only the
invoice number, invoice period, paid to date amount and the contract manager’s certification will
need to be provided.
While the contract manager’s certification must be signed for each individual invoice, the agency
management certification does not need to be signed for each invoice. The agency management
certification must be provided initially for agreements. Thereafter, the agency management
certification will be required to be updated at the time the agreement is amended or renewed.
Questions regarding this memorandum may be addressed to Laura Anderson at 850-413-5730,
Laura.Anderson@myfloridacfo.com or Cheri Greene at 850-413-5593,
Cheri.Greene@myfloridacfo.com.
SUMMARY OF CONTRACTUAL SERVICES AGREEMENT/PURCHASE ORDER
OLO/Department:
Agency Contact:
Contract/PO #:
Telephone #:
Contractor/Vendor/Payee:
Total Contract Amount:
Contract Start Date:
Contract Last
Signed Date:
Contract End Date:
Contract Signed
by Name:
Job
Title:
TYPE OF SERVICES:
Method of Payment:
Fixed Rate
Lump Sum
Cost Reimbursement
Advance Funded
Deliverables Including Minimum Performance Standards
METHOD OF PROCUREMENT:
ITB
RFP
Single/Sole
Source
ITN
Cost Plus (any combination)
YES
NO
Payment Amount
REF #
Emergency Certification
Other
(Specify)
*AGENCY MANAGEMENT CERTIFICATION:
I certify, by evidence of my signature below, the above information is true and correct; and accurately reflects the terms and conditions
of the executed contract document on file. I understand that the office of the State Chief Financial Officer reserves the right to require
additional documentation and/or to conduct periodic post-audits of any agreements.
Management Name printed:
Job Title:
Management Signature:
Date:
Invoice Number:
Invoice Period:
Total Amount of Previous Payments:
CONTRACT MANAGER CERTIFICATION:
I certify, by evidence of my signature below, the above information is true and correct; the goods and services have been satisfactorily
received and payment is now due. I understand that the office of the State Chief Financial Officer reserves the right to require additional
documentation and/or to conduct periodic post-audits of any agreements.
Contract Manager Name printed:
Contract Manager Signature:
Date:
Attachment A
Amendments/Renewals
OLO/Department:
Contract/PO #:
Contractor/Vendor/Payee:
Original Contract
Start Date:
Agency Contact:
Telephone #:
Original Contract
End Date:
AMENDMENT 1
Contract Last
Signed Date:
Total Contract amount:
Contract Signed by
Name:
RENEWAL
Job
Title:
AMENDMENT 2
Contract Last
Signed Date:
Total Contract amount:
Contract Signed by
Name:
Job
Title:
AMENDMENT 3
Contract Last
Signed Date:
Total Contract amount:
Contract Signed by
Name:
Job
Title:
Instructions to complete the Summary of Contractual Services Agreement/Purchase Order Form:
This form should be completed in its entirety, signed and dated by the appropriate agency personnel and submitted with
each payment request. Please ensure each field on the form is completed according to the guidance provided.
OLO/Department:
Agencies numeric identifier (i.e. 640000/Department of
Health).
Agency Contact:
Agency designated personnel to answer questions regarding payment.
Telephone #:
Designated personnel phone number.
Total Contract Amount:
Provide the contract amount; amount must equal the total amount of the
contract; including amendments and/ or renewals.
Total Amount of Previous Payments:
Provide the cumulative total of the payments to date, excluding current
invoice amount (s).
Contract/Agreement/PO/DO#:
Identify number assigned to agreement.
Contractor/Vendor/Payee:
Identify Vendor/Payee (including d/b/a if applicable).
Contract Start Date:
Identify date contract begins.
Contract End Date:
Identify date contract ends.
Contract Last Signed Date:
Identify date of execution.
Contract Signed by Name:
Identify the individual who executed the contract.
Job Title:
Identify the job title of the individual who executed the contract.
Type of Services:
Provide a brief description of the services being provided.
Method of Payment:
Check the appropriate method of payment.
Invoice Number:
Identify the invoice number associated with this payment request.
Invoice Period:
Identify the invoice period this payment request covers.
Deliverables…Min Performance:
All deliverables and minimum performance standards as stated
in the agreement must be provided. Pages from the agreement
referencing the deliverables and minimum performance standards may
be attached.
Payment Amount
Identify the payment criteria (compensation) for each deliverable.
Method of Procurement:
Check the appropriate procurement method; identify specific ITB, RFP or
ITN number. If first payment is being submitted on a competitively
procured agreement, provide documentation evidencing procurement
(e.g. bid tab). If Other is selected provide the specific exemption,
statute, CSFA, CFDA or GAA line item.
*Agency Management Certification:
This section is to be completed by the level of management Bureau Chief
(or equivalent) or higher that has direct knowledge of the contract
document and can attest to the information provided on this form is true
and correct and accurately reflects the terms and conditions in the
executed contract document.
Management Name:
Print name of the appropriate agency personnel.
Job Title:
Print job title of the appropriate agency personnel signing form.
Management Signature:
Signature of the appropriate agency personnel.
Date:
Enter the date signed by the appropriate agency personnel.
Contract Manager Certification:
This section is to be completed by the employee designated by the
agency to function as the contract manager and is approving the
identified invoice for payment based on direct knowledge of satisfactory
receipt of the goods or services. If the individual completing this section
is not the designated contract manager, please provide justification or
delegation of authority for the individual to sign this form.
Contract Manager Name:
Print name of the appropriate agency personnel.
Contract Manager Signature:
Signature of the appropriate agency personnel.
Date:
Enter the date signed by appropriate agency personnel.
ATTACHMENT A
AMENDMENTS/RENEWAL:
This page is to be used to identify any amendments that have been
executed. Additional records may be entered as necessary.
Contract Last Signed Date:
Identify date of execution.
Contract Signed by Name:
Identify the individual who executed the contract.
Job Title:
Identify the job title of the individual who executed the contract.
Total Contract Amount:
Provide the contract amount; amount must equal the total amount of the
contract; including amendments and/ or renewals.